Walkable, activity-friendly neighbourhoods are recommended for their benefits for non-communicable diseases, environmental sustainability, and economic performance. But how do activity-friendly neighbourhoods function during infectious disease pandemics like COVID-19? The spread of COVID-19 in some of the world’s dense cities has raised concerns about the risks of urban density and public transit. However, there are several pathways by which dense, mixed-use neighbourhoods with transit access and recreation facilities can reduce the risk of both infectious diseases and non-communicable diseases. Reducing health inequities is a core value for public health, and we comment on strategies for equitably creating activity-friendly communities.
Introduction: Active commuting — walking and bicycling for travel to and/or from work or educational addresses — may facilitate daily, routine physical activity. Several studies have investigated the relationship between active commuting and commuting stress; however, there are no studies examining the relationship between solely bicycle commuting and perceived stress, or studies that account for environmental determinants of bicycle commuting and stress. The current study evaluated the relationship between bicycle commuting, among working or studying adults in a dense urban setting, and perceived stress.
Methods: A cross-sectional study was performed with 788 adults who regularly travelled to work or study locations (excluding those who only commuted on foot) in Barcelona, Spain. Participants responded to a comprehensive telephone survey concerning their travel behaviour from June 2011 through to May 2012. Participants were categorised as either bicycle commuters or non-bicycle commuters, and (based on the Perceived Stress Scale, PSS-4) as either stressed or non-stressed. Multivariate Poisson regression with robust variance models of stress status based on exposures with bicycle commuting were estimated and adjusted for potential confounders.
Results: Bicycle commuters had significantly lower risk of being stressed than non-bicycle commuters (Relative Risk; RR (95% CI)=0.73 (0.60 to 0.89), p=0.001). Bicycle commuters who bicycled 4 days per week (RR (95% CI)=0.42 (0.24 to 0.73), p=0.002) and those who bicycled 5 or more days per week (RR (95% CI)=0.57 (0.42 to 0.77), p<0.001) had lower risk of being stressed than those who bicycled less than 4 days. This relationship remained statistically significant after adjusting for individual and environmental confounders and when using different cut-offs of perceived stress.
Conclusions: Stress reduction may be an important consequence of routine bicycle use and should be considered by decision makers as another potential benefit of its promotion.
According to the World Health Organization (WHO) air pollution in urban areas, mainly associated with inhalation of gaseous pollutants and particulate matter emitted from motor vehicles, is responsible for one million deaths per year. Carbon monoxide (CO) from the incomplete combustion of fuel is known to bind with hemoglobin, decreasing the blood oxygen-delivery and inducing tissues hypoxia; being more pronounced under conditions of stress like physical activity. The present study demonstrates the usefulness of a compact CO sensor (Alphasense CO-B4) mounted on a bicycle to evaluate atmospheric levels of CO associated with urban microenvironments within a growing Australian city (Brisbane). Urban bike pathways show pronounced and significant variations in air quality according to the surrounding microenvironment and the time of day. The inhaled dose in real time and the CO total dose over each trip were valuable for estimating the air quality of the route, and identifed how the health benefits of riding a bicycle could be partially offset by poor air quality depending on where and when a cycle route is taken in the inner-city. Finally, environmental conditions, such as wind speed, were found to significantly affected atmospheric CO concentrations, at least during the study period. The present work provides information regarding commuters' exposure to atmospheric pollutants, necessary for modifying the population's (including cyclists) perception of pollution in the urban environment, providing people with the opportunity to choose a healthier route.
Results: 2430 participants died (496 were related to CVD and 1126 to cancer) over a median of 5.0 years (interquartile range 4.3-5.5) follow-up. There were 3748 cancer and 1110 CVD events. In maximally adjusted models, commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality (cycling hazard ratio 0.59, 95% confidence interval 0.42 to 0.83, P=0.002; mixed mode cycling 0.76, 0.58 to 1.00, P<0.05), cancer incidence (cycling 0.55, 0.44 to 0.69, P<0.001; mixed mode cycling 0.64, 0.45 to 0.91, P=0.01), and cancer mortality (cycling 0.60, 0.40 to 0.90, P=0.01; mixed mode cycling 0.68, 0.57 to 0.81, P<0.001). Commuting by cycling and walking were associated with a lower risk of CVD incidence (cycling 0.54, 0.33 to 0.88, P=0.01; walking 0.73, 0.54 to 0.99, P=0.04) and CVD mortality (cycling 0.48, 0.25 to 0.92, P=0.03; walking 0.64, 0.45 to 0.91, P=0.01). No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes. Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes.
Conclusions: Cycle commuting was associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions.
17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3–9%), and cardiovascular mortality by 15% (3–27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1–25%), and cycling decreased significantly both all-cause mortality by 21% (11–31%) and cardiovascular mortality by 33% (10–55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3–19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2–28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8–30%) and by 31% (9–52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5–42%), high level of active commuting (14%, 4–24%), and high level of active commuting by walking (16%, 0–32%). Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose–response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.
Previous research has investigated satisfaction with work commutes. We extend this research by investigating whether satisfaction with all daily travel (including work commutes, school, leisure, and shopping trips) is related to life satisfaction and emotional well-being. A random sample of 367 participants was recruited from three urban areas in Sweden (Karlstad, Göteborg, and Stockholm) varying from a small (appr. 90,000 residents) through a medium (appr. 550,000 residents) to a large population size (appr. 925,000 residents). In a questionnaire the participants reported retrospectively their satisfaction with all daily travel, life satisfaction, and emotional well-being. Direct and indirect effects of travel satisfaction on life satisfaction and emotional well-being were analysed with PLS-SEM. Results showed that satisfaction with daily travel directly influences emotional well-being and both directly and indirectly life satisfaction. It is also found that driving and active modes have more positive effects than public transport.
The sale of electrically assisted bicycles (‘e-bikes’) is growing at a rapid rate across Europe. Whereas market data is available describing sales trends, there is limited understanding of the experience of early adopters of e-bike technology. This paper investigates the motives for e-bike purchase, rider experience and perceived impact on mobility, health and wellbeing through in-depth interviews with e-bike owners in the Netherlands and the UK.
Findings revealed that the motive for purchasing e-bikes was often to allow maintenance of cycling against a backdrop of changing individual or household circumstances. E-bikes also provided new opportunities for people who would not otherwise consider conventional cycling. Perceptions of travel behaviour change revealed that e-biking was replacing conventional cycling but was also replacing journeys that would have been made by car. There was also a perception that e-biking has increased, or at least allowed participants to maintain, some form of physical activity and had benefitted personal wellbeing. Technological, social and environmental barriers to e-biking were identified. These included weight of bicycle, battery life, purchase price, social stigma and limitations of cycle infrastructure provision.
Additional research is necessary to quantify actual levels of mode substitution and new journey generation among new e-bike owners and the impact of e-biking on promoting physical health and mental wellbeing.
Background: The number of individuals turning to cycling for physical activity and commuting has been expanding across the US. However, studies have demonstrated that when compared to motor vehicle accidents, cyclists in major cities have a significantly increased risk of injuries requiring hospitalizations. The purpose of this study was to assess if a correlation exists between the growing cyclist volume in a densely populated metropolitan city and prevalence of clavicle fractures requiring inpatient hospital admissions.
Hypothesis: A correlation exists between the increased number of cyclists and the increasing number of clavicle fractures requiring inpatient hospital admissions.
Methods: Patients who sustained a clavicle fracture that required an inpatient admission were identified using the New York Statewide Planning and Research Cooperative System (SPARCS). The location of hospital admission was screened using New York City (NYC) hospital county codes, as only clavicle fractures presenting to NYC hospitals were included in the analysis. This study was exempt from Institutional Review Board (IRB) approval. Public transportation data was available through the Department of Transportation (DOT) and The Decennial Census. These databases are publicly available and are performed to assess if New Yorkers are using cycling as a mode of transportation. The cycling data included the following information in a given year: the number of people in NYC who use a bicycle as their primary mode of commuting to work, the number of daily cycling trips, total bicycle protected bike lane mileage, midtown Manhattan cycling counts and East River Bridge cycling counts. Spearman’s correlation analysis was conducted between the numbers of patients with clavicle fractures per year and the described data for that specific year. Additionally, the number of bicycle-share program miles traveled per month and total number of cycling trips that month were obtained from the public bicycle-sharing program database from June 2013 through June 2015. Spearman’s correlation analysis was conducted between the numbers of patients with clavicle fractures per month and total bicycle-sharing miles and trips traveled per month.
Results: The increasing daily cycling trips in NYC has a strong correlation with the increasing number of clavicle fractures in NYC (rs = .979, p < 0.001). The increasing use of a bicycle as transportation to work has a strong positive correlation with the increasing number of clavicle fractures in NYC (rs = .988, p < 0.001). There was a strong positive correlation between the mileage of bicycle lanes in NYC and the number of clavicle fractures (rs = .867, p = 0.001). A strong positive correlation exists between NYC clavicle fracture number and public bicycle-sharing miles (rs = .819, p < 0.001) and trips (rs = .811, p < 0.001).
Conclusion: There are many physical benefits to cycling. Cycling, as a means of transportation, has been encouraged to decrease CO2 emissions from vehicular transportation. These benefits do not come without risks, as this study shows a correlation between increased cycling and clavicle fractures.
Clinical Relevance: Physicians and public health officials should be aware of the dangers of cycling in major cities in order to create safer routes for this environmentally beneficial route of transportation.
The stress of commuting has serious public health and social implications. By comparing stress across different modes it is possible to determine which modes are more heavily contributing to this potential health and social issue. This study uses a large-scale university travel survey to compare commuter stress across three modes of transportation (walking, driving, and using public transit). It also investigates the specific factors that contribute to stress using these modes. Using ordered logistic regressions, the study develops a general model of stress and three mode-specific models. Results show that driving is the most stressful mode of transportation when compared to others. We also find that stressors for some modes are not stressors for others. Knowing which specific factors make certain modes stressful will help transportation and public health professionals make commuting a safer, more enjoyable, and less stressful activity; in turn this could mitigate the potentially serious health outcomes of a stressful commute.
It has been demonstrated that, on their own, both exercise and stimulation from the environment can improve cognitive function and well-being in older adults. The combined effect of exercising in the outdoor environment on psychological function is less well studied. The aim of the current study was to investigate the effect of an outdoor cycling intervention on cognitive function and mental health and well-being in older adults. A total of 100 older adults took part in the study (aged 50–83), 26 of which were non-cycling controls, 36 were conventional pedal cyclists and 38 were participants using an e-bike (a bike fitted with an electric motor to provide assistance with pedaling), as part of a larger project (www.cycleboom.org). Participants took part in the study for an eight-week period, with cycling participants required to cycle at least three times a week for thirty minutes in duration for each cycle ride. Cognitive function and well-being were measured before and after the intervention period. For executive function, namely inhibition (the Stroop task) and updating (Letter Updating Task), both cycling groups improved in accuracy after the intervention compared to non-cycling control participants. E-bike participants also improved in processing speed (reaction times in go trials of the Stop-It task) after the intervention compared to non-cycling control participants. Finally, e-bike participants improved in their mental health score after the intervention compared to non-cycling controls as measured by the SF-36. This suggests that there may be an impact of exercising in the environment on executive function and mental health. Importantly, we showed a similar (sometimes larger) effect for the e-bike group compared to the pedal cyclists. This suggests that it is not just the physical activity component of cycling that is having an influence. Both pedal cycles and e-bikes can enable increased physical activity and engagement with the outdoor environment with e-bikes potentially providing greater benefits.
There are many health benefits of regular physical activity and improving physical fitness levels can reduce the risk of chronic disease. Accumulating evidence suggests the neighborhood built environment is important for supporting physical activity; however, few studies have investigated the contribution of the neighborhood built environment to fitness levels. We examined the associations between objectively-determined and self-reported neighborhood walkability and overall and specific components of perceived health-related fitness (cardiorespiratory, muscular strength, and flexibility) in a random sample of 592 adults from two areas of Calgary (Canada). Participants provided complete data to an online questionnaire capturing perceived cardiorespiratory fitness (CRF), muscular strength (MST), flexibility, moderate-to-vigorous intensity physical activity (MVPA), resistance training, and sociodemographic characteristics. The questionnaire also captured participant’s perceptions of their neighborhood’s walkability (Physical Activity Neighborhood Environment Scale; PANES) and the physical activity supportiveness of neighborhood parks (Park Perceptions Index; PPI). Objectively-measured neighborhood walkability was estimated using Walk Score®. The average (SD) age of participants was 46.6 (14.8) years and 67.2% were female. Participants, on average, participated in at least 30-minutes of MVPA on 3.4 (2.1) days/week and undertook resistance training 2.0 (1.8) days/week. Adjusting for covariates, Walk Score® was not associated with any fitness outcomes. Adjusting for covariates, the PANES index was positively associated (p < 0.05) with CRF, MST, flexibility, and overall fitness and the PPI was positively associated (p < 0.05) with all fitness outcomes except MST. Our findings provide novel preliminary evidence suggesting the neighborhood built environment may be important for supporting higher health-related fitness levels in adults.
Micro-mobility (MM) is usually presented as an environmental friendly, flexible and socially inclusive new group of travel modes. This chapter first defines and then explores the social sustainability potential of MM by providing an overview of MM implications for accessibility, air pollution, safety, physical activity and subjective wellbeing. Our results show that MM could enhance accessibility, yet costs, physical ability and technical skills might exclude certain social groups from using such modes. MM modes have no or limited direct CO2 emissions but environmental effects are uncertain if we account for the production of these modes. Road safety could be enhanced due to mutual awareness stimulation, but also compromised due to speed differential between MM and other modes. Physical activity could be increased or reduced depending on whether MM modes are electric or not. Exercising, enjoying the scenery, and having fun could enhance subjective well-being of MM mode users, while perceived safety risk could negatively influence subjective well-being. We conclude that MM sustainability potential should not be automatically assumed and could vary among the different MM modes. We suggest a set of regulatory actions with regards to permission, operation and monitoring of MM systems that could enhance their social sustainability.
The lack of bike lane access has been a proven risk factor for childhood obesity due to its role in discouraging healthy lifestyles. However, there has not been a systematic review of this important association in the existing literature. This study aims to fill this gap. A literature search was conducted in the Cochrane Library, PubMed, Embase, and Web of Science for studies published from 1 January 2019 onwards that examined the association between bike lane access and weight-related behaviours and outcomes among children aged <18 years. A total of 21 studies were included in this systematic review. Among them, most of the studies showed that bike lane access was significantly associated with children and adolescents' physical activity (PA), whereas only two studies showed a negative association. Meta-analysis also supported these findings and showed that bike lane access was significantly associated with children and adolescents' PA (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.37–1.81). Additionally, we reviewed how bike lane characteristics and microenvironment variables such as children and adolescents' choice of bicycle travel mode, the degree of separation of cycle path, cycle path unevenness, and street maintenance were associated with adolescents' preferences and intention to cycle. This systematic review and meta-analysis strongly suggests that bike lane access is associated with children and adolescents' PA. Nonetheless, it was difficult to draw a conclusion on the association between bike lane access and weight-related outcomes.
Objective: To estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment.
Design: Health impact assessment study.
Setting: Public bicycle sharing initiative, Bicing, in Barcelona, Spain.
Participants: 181,982 Bicing subscribers. Main outcomes measures The primary outcome measure was all cause mortality for the three domains of physical activity, air pollution (exposure to particulate matter <2.5 µm), and road traffic incidents. The secondary outcome was change in levels of carbon dioxide emissions.
Results: Compared with car users the estimated annual change in mortality of the Barcelona residents using Bicing (n = 181,982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77). The annual number of deaths avoided was 12.28. As a result of journeys by Bicing, annual carbon dioxide emissions were reduced by an estimated 9,062,344 kg.
Conclusions: Public bicycle sharing initiatives such as Bicing in Barcelona have greater benefits than risks to health and reduce carbon dioxide emissions.
Walking (5%) and cycling (3%) to work were uncommon. Compared with people reporting using motor vehicles to travel to work, those cycling had a reduced all-cause mortality (ACM) in the socio-demographic adjusted models RR 0.87 (0.77–0.98). Those walking (0.97, 0.90–1.04) and taking public transport (0.96, 0.88–1.05) had no substantive difference in ACM. No mode of transport was associated with detectable statistically significant reductions in cause-specific mortality. Sensitivity analyses found weaker associations when adjusting for smoking and stronger associations correcting for likely non-differential misclassification of cycling.
Objectives The study aims to make use of individual data to estimate the impact on premature mortality due to both existing commuter bicycling and the potential impact due to increased physical activity through shifting transport mode from car commuting to bicycling.
Methods Using registry data on home and work addresses for the population of Stockholm County the shortest bicycling route on a network of bicycle paths and roads was retrieved. Travel survey data were used to establish current modes of commuting. The relation between duration of bicycling and distance bicycled within the general population in 2015 was established as a basis for identifying individuals that currently drive a car to work but were estimated to have the physical capacity to bicycle to work within 30min. Within this mode-shift scenario from car-to-bike the duration of bicycling per week was estimated, both among current and potential bicycle commuters. The health impact assessment (HIA) on mortality due to bicycle commuting physical activity was estimated using the same relative risk as within the WHO Health Economic Assessment Tool.
Results The current number of bicycle commuters were 53 000, and the scenario estimated an additional 111 000. Their mean bicycle distances were 4.5 and 3.4 km, respectively. On average these respective amounts of physical activity reduced the yearly mortality by 16% and 12%, resulting in 11.3 and 16.2 fewer preterm deaths per year.
Conclusion The HIA of transferring commuting by car to bicycle estimated large health benefits due to increased physical activity.
Urban transportation is an important determinant of health and environmental outcomes, and therefore essential to achieving the United Nation's Sustainable Development Goals. To better understand the health impacts of transportation initiatives, we conducted a systematic review of longitudinal health evaluations involving: a) bus rapid transit (BRT); b) bicycle lanes; c) Open Streets programs; and d) aerial trams/cable cars. We also synthesized systems-based simulation studies of the health-related consequences of walking, bicycling, aerial tram, bus and BRT use.
Two reviewers screened 3302 unique titles and abstracts identified through a systematic search of MEDLINE (Ovid), Scopus, TRID and LILACS databases. We included 39 studies: 29 longitudinal evaluations and 10 simulation studies. Five studies focused on low- and middle-income contexts. Of the 29 evaluation studies, 19 focused on single component bicycle lane interventions; the rest evaluated multi-component interventions involving: bicycle lanes (n = 5), aerial trams (n = 1), and combined bicycle lane/BRT systems (n = 4). Bicycle lanes and BRT systems appeared effective at increasing bicycle and BRT mode share, active transport duration, and number of trips using these modes. Of the 10 simulation studies, there were 9 agent-based models and one system dynamics model. Five studies focused on bus/BRT expansions and incentives, three on interventions for active travel, and the rest investigated combinations of public transport and active travel policies. Synergistic effects were observed when multiple policies were implemented, with several studies showing that sizable interventions are required to significantly shift travel mode choices.
Our review indicates that bicycle lanes and BRT systems represent promising initiatives for promoting population health. There is also evidence to suggest that synergistic effects might be achieved through the combined implementation of multiple transportation policies. However, more rigorous evaluation and simulation studies focusing on low- and middle-income countries, aerial trams and Open Streets programs, and a more diverse set of health and health equity outcomes is required.
In this thesis, a cross-sectional study investigates whether mobility choices and some selected socio-demographic variables can explain subjective well-being. A logistic regression model is conducted for simplified analysis of predictors. The results support that active traveling and car ownership are positively related to subjective well-being. Frequent walking and cycling predict high quality of life and self-rated health. Public transport did not show any significant results from the model but active public transport users walk more than people who use less public transport. For women, active walking predicted the highest self-rated health. More cars in a household predicted also high subjective wellbeing especially for men.
There is substantial evidence that the environment has an important impact on the use of bicycles. Changes in the built environment, such as cycling infrastructure provision, usually aim at improving the efficiency, enjoyability and safety of cycling. They can also shape affective responses, for instance by triggering or preventing stress situations during cycling. The repeated occurrence of intensely stressful events may make actual cyclists more likely to abandon cycling and deter prospective cyclists from actually taking up this form of mobility. Therefore, using a novel approach, based on stress biomarker measurements obtained directly from cyclists, the objective of this study is to investigate the relationship between urban environment and cyclists' stress. It also investigates if different types of cycling infrastructures in the contexts of two different countries and in five different cities have different relationships with stress. Using a stress sensor, 70 young adults were invited to cycle along a standard route in Oxford, London (the United Kingdom), Amsterdam, Houten and Groningen (the Netherlands). These routes were around 6 km long and had a wide range of characteristics. Multilevel logistic regression analysis indicates that the probability of stressful events occurring is significantly lower on physically segregated cycle paths than on cycle paths on streets, with cycling on general use streets falling in-between these extremes. We also find higher probabilities of stress for primary roads compared to tertiary roads, at intersections than on straight roads, on cobbled and off-road surfaces compared to asphalt, and in noisier places. Models for the individual cities suggested that the relationship between cycling infrastructure and the likelihood of stressful events occurring may depend on the local context. Only for noise conditions, intersection types and cycling infrastructures were the effects consistent across the cities. These findings may be useful for urban infrastructure planning and management, indicating specific attributes that should be adjusted to make cycling less stressful.